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Monday Oct 09, 2017

But I Already DID Refer You to an 'American' Doctor

Ancestry and genetics are fascinating. There is a lot of interest in genetic testing, and I don't just mean for medical treatment or diagnostic purposes.

Multiple companies are succeeding at marketing ancestry testing to the general public. To make a long story short, my son was intrigued and wanted to be tested for his birthday, which means I now know my own ancestry details.  

[Physicians looking at tablet]

We eagerly awaited the data after we submitted a cheek swab in the mail. We had lived vicariously through our friends and acquaintances who received exciting information about their ancestry, and saw advertisements showing people receiving unexpected news that led them to explore parts of the world they hadn't known they were connected to.

I am white, but not all racial phenotypes are obvious, especially if they were incorporated into your genome long ago. Well, it turns out that I'm even whiter than I anticipated. All my genetic data traced straight to England, not a hint from anywhere elsewhere. All white. All England.

About the same time I received my overwhelmingly white racial data, I was also on the receiving end of many comments from white patients about other doctors, specifically about their race, ethnicity or religion. Maybe I paid more attention because I had this new information that made me self-conscious about my own whiteness, or maybe the comments came in higher numbers than usual. Either way, they came. And what I started to realize is that the only reason these patients are sharing these comments with me is because I'm white, too.

Unfortunately, these commenters falsely assume that it is OK to voice these bigoted opinions to me, not recognizing the problem inherent in their having these thoughts in the first place. Nearly all my patients are white. I have a couple of mixed-race patients and one black patient, and that is fairly representative of my geographical area for at least a few contiguous counties.

Clay County, W.Va., made headlines for some awful reasons in the past year, first for one resident's racist statements about Michelle Obama and more recently for a bullying incident involving a gay student. If you read these stories from afar, you might think everyone who lives here fosters the same bigoted opinions, but that is not the case. For every patient who has spouted a racial slur in my office, there are three who have voiced their disappointment in such hateful speech and behavior.

We are taught to accommodate patients, that patients can choose their care teams, that the patient-physician relationship is important. We need our patients to trust us and value the advice we give them. We also want patients to feel at ease when they go for procedures or surgeries. However, in some areas, we don't have enough subspecialists for patients to pick and choose a doctor based on race or ethnicity. And there is also the reality that the best doctor for a patient may be the one they don't want to see.

As I've worked through a few of these situations with patients, I've become much more vocal and taken on a physician advocate role because despite the patient's perception, I am still trying to get them the best care possible. I am not willing to sacrifice the level of care my patients receive to accommodate systemic racism.

I had a patient ask for a different cardiologist because hers was "from the Middle East," and she didn't trust anyone from there. I had a patient ask for a different surgeon because hers was Muslim. And I have scores of people who say, "I want you only to refer me to American doctors," to which I laugh because my definition of American surely isn't the same as theirs. Americans, obviously, aren't necessarily white.

During medical school and residency, I worked in a hospital with doctors from all sorts of backgrounds. And I learned not only about their religious practices, which often included significant sacrifices that make Lenten abstention from chocolate look weak, but also about their mind-blowing dedication to their profession. During the month of Ramadan, Muslim doctors would fast during daylight hours, but then were so busy caring for patients overnight that they didn't eat for days. They went straight from one patient to another without stopping to eat or drink because they put the patient first, not themselves. They sometimes left behind their parents, grandparents, siblings, spouses and children, occasionally in extremely dangerous countries, to come to the United States to learn and/or work.

Our medical system could not survive without immigrants, who make up more than one-fourth of our physician workforce(www.migrationpolicy.org). The immigrant doctors who come here to save lives often become citizens. And far too many doctors are presumed to be immigrants because of their skin color or religion, despite the fact that they were born in the United States (as were their parents, grandparents and great-grandparents). They are as American as I am.

I tell my patients if they can't understand a doctor I referred them to because of a foreign accent, they can call me and I will talk to their doctor. Often the misunderstandings stem from medical terms, not the English language, and their consult notes will clearly outline the diagnosis and treatment plan.

I want to remove language from the equation of these patients' racist perceptions. I reinforce with my patients that I trust the doctors I send them to see, and I tell them I would choose those same doctors to take care of me if I had their condition.

Leadership by example is always the most effective way to make change. I recently accepted a position on the board of a local nonprofit organization that made national headlines last year because of its (now former) director's racist social media posts. Although I could literally be the whitest person here, I am trying to be the advocate our minority doctors need, because our patients can't survive without them, and they are amazing and deserve our respect and admiration.

Kimberly Becher, M.D., practices at a rural federally qualified health center in Clay County, W.Va.

Posted at 02:15PM Oct 09, 2017 by Kimberly Becher, M.D.

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